Quinine: The age-old anti-malarial drug whose efficacy lasts the risks

For over 400 years, Quinine has been the most effective drug to treat malaria regardless of the several risks it carries when administered poorly. It has been both a life saver and an undertaker for unlucky ones. From being administered as an injection on the buttock, quinine administration transformed to intravenous administration in a drip containing glucose solution. Dr Osée Sebatunzi, the director of Kibagabaga Hospital, says the use of quinine on the buttocks is outdated. “Quinine is both a healer and a killer. Administration on the buttocks carries a lot of risk on a patient unless it is administered by an expert and in a proper way. With the drip containing glucose, the eight hour gap in the dosage reduces risk and makes it safer to use and doesn’t need a lot of technical knowhow as compared to the buttock administration,” he noted He furthermore went ahead to say that intravenous administration has helped to minimise risk and at the same time keep the efficacy of the drug that has been used for years. What makes quinine so useful? Anastase Nkurikiye, a pharmacist at Good Will Pharmacy says Quinine has rapid action against malaria parasites but what makes it so special is that it is rich in proteins and is quickly distributed throughout the body fluids. “Due to its rapid absorption, it reaches peak concentration in a few hours. Just 1-3 hours depending on the patient, and this makes it every efficient. It’s excretion is also rapid making it favorable,” kurikiye said. He said the Quinine which he described as unique works differently, according to the severity of the disease, making it work better when one is in critical condition. “Severe malaria needs quick attention and this can only be realised through intravenous anti-malaria administration and quinine is so far the one drug that has kept its stand as far as dealing with such scenario is concerned,” he concluded. How safe is intravenous administration? Dr Melence Gatsinda, the managing director of Clinique Don de Dieu in Kicukiro, says intravenous administration of Quinine is equally dangerous when not safely and effectively administered. “The health expert, must pay attention to detail of weight of the patient and the pressure of the liquid (Quinine plus Glucose solution) as it comes out of the drip and the time interval between the two drips. Failure to do that, the patient could suffer from Hypotension if the drug is given too rapidly, Hypoglycaemia is also a very common effect of Quinine,” he warned. He also advised that sometimes it’s not the problem of the health expert but could be an accident or the fault of the patient or people taking care of them. “The nurse or doctor could move out and an ignorant patient or the one taking care of them decides to increase the flow of the liquid in the drip and things could go wrong from there,” Dr Gatsinda said, adding that the one in charge should keep timely watch of the rate of flow of the liquid and make sure it is the one they set, before one gets into a worse situation. Emergency treatment to poor administration Dr Gatsinda says when the doctor or nurse realises that things have gone wrong, they should immediately remove the drip containing Quinine and replace it with a drip rich in glucose which isn’t containing any antidote. “This does help a lot because the drip is rich in nutrients though if the nurse or doctor realises it late, then it should be handled as a delicate case,” he said. Patient’s role in drug administration “Quinine is usually administered to patients with severe malaria and in critical state,” Dr Gatsinda said. “In this state, the patient can’t comment or do anything about what is happening. This means that all the work is left to the nurse or doctor and they should be very keen while administering this drug,” he added. *** WHY QUININE WILL STAND THE TEST OF TIME Faith Mugabo,32, says when she has malaria, Quinine is the drug that gets her well. However, it leaves her with a few side effects which do not last. “After getting Quinine, I often get a hearing problem, nausea also affects me a lot and I also suffer from continuous headaches which go on for like a week,” she narrated. “Even with all this, only Quinine actually does treat my malaria,” she added. Pharmacist, Anastese Nkurikiye says Quinine is effective and will continue to be used until another drug is discovered. “When patients, hospitals or medical centres are thinking of drugs to buy, they have to consider efficiency and cost involved. Malaria drugs that have been discovered are either too expensive or aren’t as efficient as Quinine,” he said. He also went ahead to say that for those reasons, Quinine is going to be used for sometimes especially in Africa.